Two separate works are part of the MATRIX study investigating strategies to reduce bleeding and mortality in patients with acute coronary syndrome. The first part of the work that was simultaneously published in The Lancet found a significant reduction in major bleeding and mortality in patients undergoing coronary angiography and angioplasty using radial versus femoral access.

The study included 8404 patients undergoing an acute coronary syndrome randomized 1: 1 to radial versus femoral access of 78 centers in Italy, the Netherlands, Spain, and Switzerland. The group receiving radial approach had a lower rate of combined clinical events than the femoral group (8.8% versus 10.3%). The difference was based on bleeding and all-cause mortality. In the second part of the study no significant benefit in cardiac events and cardiac events more bleeding in patients receiving bivalirudin versus standard treatment was observed. However the difference reached significance in favor of bivalirudin to consider only death.

The difference of this study with others is that IIbIIIa glycoprotein inhibitors were used in the control group only in one quarter of the population and at the discretion of the surgeon.

Conclusion

In patients undergoing an acute coronary syndrome with or without ST-segment elevation using the radial versus femoral access reduces clinical events and bivalirudin may have an additional benefit.

Marco Valgimigli
2015-03-18

Original title: Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX: Radial vs. Femoral Clinical Trial – MATRIX: Radial vs. Femoral